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General NPI Number Information
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NPI Number | 1831421296
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Entity Type | Individual
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Provider Name | MELISSA WARDLOW LMT
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Gender | Female
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Dates
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Enumeration Date | 02/09/2010
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 211 N HIGGINS AVE STE 403
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City | MISSOULA
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State | MT
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Zip | 59802-4488
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Country | US
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Telephone | 808-652-6501
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Fax |
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Provider Business Mailing Address
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Address Line | 832 LOCUST ST
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City | MISSOULA
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State | MT
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Zip | 59802-3720
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | LMT-MLT-LIC-6080
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | LMT-LMT-LIC-6080
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License Number State | MT
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